Colorectal Cancer in TexasPrepared by the Texas Cancer RegistryTexas D - PDF document

Colorectal Cancer in TexasPrepared by the Texas Cancer RegistryTexas Department of State Health ServicesJune 2019 Index of Select Slides Colorectal Cancer Overview Colorectal Cancer Screening Colorectal Cancer Screening Prevalence Colorectal Cancer Screening in Texas Overview of Colorectal Cancer Incidence Overview of Colorectal Cancer Mortality and Survival Colorectal Cancer Incidence in Texas Incidence Rates by Sex and Age at Diagnosis Incidence Rates by Sex and Race/Ethnicity • Incidence Rates by Age at Diagnosis and Tumor Location • Incidence Rates by Race/Ethnicity and Diagnosis Stage Incidence Rates by Age and Stage • Incidence Rates by UrbanRural Classification Incidence Rates by Health Service Region Incidence Rates Trends by Sex Incidence Rate Trends by Age at Diagnosis • Incidence Rate Trends by Age at Diagnosis and Sex Incidence Rate Trends by Sex and Race/Ethnicity • Incidence Rate Trends by Age at Diagnosis and Race/Ethnicity • Incidence Rate Trends by Metro/NonMetro Counties Colorectal Cancer Mortality in Texas Mortality Rates by Sex and Age at Diagnosis • Mortality Rates by Sex

and UrbanRural Classification Mortality Rates by Health Service Region Mortality Rate Trends by Age at Diagnosis Mortality Rate Trends by Race/Ethnicity Colorectal Cancer Survival in Texas • CauseSpecific Survival by Stage and Race/Ethnicity Relative Survival by Stage and Age at Diagnosis ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 BackgroundColorectal cancer screening is the only agebased cancer screening currently recommended for all adults by the U.S. Preventive Services Task Force.Breast and cervical cancer screenings are also recommended for all women.According to the Centers for Disease Control and Prevention, routine colorectal cancer screening is the most effective way to reduce the risk of colorectal cancer.Screenings can help prevent colorectal cancer by identifying and removing precancerous polyps before they turn into cancer. Screening can also find colorectal cancer early, when it is easier to treat.This statistical report describes colorectal cancer screening prevalence and the burden of colorectal cancer in Texas.Implications for Public Health PracticeThe burde

n of colorectal cancer can be reduced through efforts to screen a large percentage of the population at risk and by encouraging healthy lifestyles that reduce modifiable risk factors.Identifying health disparities in colorectal cancer incidence, mortality, and survival can help determine and implement strategies to reduce the cancer burden.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��3&#x/BBo;&#xx [1;.04;2 5;.44;8 3;D.8;࠲ ;e.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;8 3;D.8;࠲ ;e.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;1Colorectal Cancer: Screening. United States Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectalcancerscreening2 ��2 What Can I Do to Reduce My Risk for Colorectal Cancer? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/colorectal/basic_info/prevention.htm Colorectal Cancer Overview

Colorectal cancer (CRC) is cancer that starts in the colon or rectum.The colon and rectum make up the large intestine.Most CRCs begin as adenomatous polyps (precancerous growths called adenomas) that grow slowly over 1020 years.Although all adenomas have the potential to become cancerous, fewer than 10% become an invasive cancer. 90% of all CRCs are adenocarcinomas which arise from the inner lining of the colon or rectum.The most common colorectal tumor location is the proximal colon (37% of cases), which includes the cecum, ascending colon and transverse colon. The second most common location is in the rectum (30%). ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��4&#x/BBo;&#xx [1;.49;v 3;.24;9 2;v.7;ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 3;.24;9 2;v.7;ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Image: What is Colorectal Cancer? American Cancer Society. https://www.cancer.org/cancer/colonrectalcancer/

about/whatiscolorectalcancer.html Colorectal Cancer SymptomsSymptoms of colorectal cancer include: Bleeding from the rectumBlood in the stoolDark or black stoolsA change in bowel habits or shape of the stool (e.g., more narrow than usual)Cramping or discomfort in the lower abdomenAn urge to have a bowel movement when the bowel is emptyConstipation or diarrhea that lasts for more than a few daysDecreased appetiteUnintentional weight loss��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 Colorectal CancerModifiable Risk FactorsModifiable risk factors contribute to around 55% of cases and include:Overweight/obesity, especially in menPhysical inactivityDiets high in red or processed meatsDiets low in fiber, fruit, and vegetablesSmokingHeavy alcohol use��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��6&#x/BBo;&#xx [1;.04;2 3;.24;9 2;A.2;f ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.04;2 3;.24;9 2;A.2;f ;F.1;́ ;&#x]/Su;

typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1Islamiet al. (2017). CA Cancer J. Clin. 68(1):31 Colorectal CancerUnmodifiable Risk FactorsRisk factors for colorectal cancer that you cannot change include:AgeFamily history of colorectal polyps or colorectal cancer (One of three people who develop colorectal cancer have other family members with colorectal cancer; however, only a small percentage of these have a hereditary syndrome.)Personal history of inflammatory bowel disease (This is different from irritable bowel syndrome, which does not increase risk.)Racial/ethnic background (African Americans and Ashkenazi Jews are at higher risk.)Type 2 diabetesCertain inherited conditions, including Lynch syndrome which causes about 4% of all colorectal cancers��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��7&#x/BBo;&#xx [1;.04;2 3;.24;9 2;g.8;в ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.04;2 3;.24;9 2;g.8;в ;F.1;́ ;&#x]/Su;typ; /F;&#

xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1Colorectal Cancer Risk Factors. American Cancer Society. https://www.cancer.org/cancer/colonrectalcancer/causesrisksprevention/riskfactors.html Colorectal Cancer ScreeningScreening is a check for cancer or abnormal cells that may become cancer in people who have no symptoms.Regular colorectal cancer screening can find polyps that can be removed before turning into cancer. Screening also helps find cancer at an early stage, when it is more easily treated.If colorectal cancer is found early, the survival rate is very high. 89% of patients diagnosed at an early stage survive at least five years after diagnosis; only 17% diagnosed at a late stage survive five years.The U.S. Preventive Services Task Force recommends colorectal cancer screening for all adults ages 5075 years.Individuals with an increased risk might follow different screening guidelines, including starting screening earlier or using specific screening methods. Due to an increase in colorectal cancer in younger age groups, some groups, including the American Cancer Society, now recommend that people at average risk start

screening at age 45.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��8&#x/BBo;&#xx [1;.04;2 5; .64;y 3;D.8;࠲ ;p.5;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.04;2 5; .64;y 3;D.8;࠲ ;p.5;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1Colorectal Cancer: Screening. United States Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectalcancerscreening2 ��2American Cancer Society Guidelines for Colorectal Cancer Screening. American Cancer Society. https://www.cancer.org/cancer/colonrectalcancer/detection diagnosisstaging/acsrecommendations.html Colorectal Cancer Screening MethodsThe U.S. Preventive Services Task Forceand the Centers for Disease Control and Preventionrecommend the following colorectal cancer screening methods for all adults between the ages of 50 and 75.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019&

#x0000;�9&#x/BBo;&#xx [1;.04;2 5;.60;8 3;D.8;࠲ ;d.4;ँ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.04;2 5;.60;8 3;D.8;࠲ ;d.4;ँ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1Colorectal Cancer: Screening. United States Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectalcancerscreening2#tab ��2Colorectal Cancer. Centers for Disease Control and Prevention. https://www.cdc.gov/dotw/colorectalcancer/ Screening MethodDescriptionFrequencyStool testsStool sampletaken at home. Test looks for blood or altered DNA in the stool. Three different tests availablegFOBT, FIT and FITDNA.Every yearfor gFOBTand FITEvery 3 years for DNAFlexiblesigmoidoscopyConducted in thedoctor’s office. Allows the doctor to view the lower third of the colon.Every five yearsColonoscopyConducted in thedoctor’s office. Allows the doctor to view the entire colonand remove most polyps and some cancers. Can also be used

as a followup if anything unusual is found using one of the other tests.Every 10 yearsVirtual colonoscopyConducted in thedoctor’s office. Uses xrays to let doctor view images ofthe colon on a computer screen.Every fiveyears Colorectal Cancer Screening PrevalenceIn 2014, the National Colorectal Cancer Roundtable launched a goal to increase the US colorectal cancer screening rate to 80%.Based on the Behavioral Risk Factor Surveillance System 2016:67% of eligible adults ages 5075 selfreported that they were updatewith colorectal cancer screening7% had been screened in the past but were not update with screeningA quarter of eligible adults had never been screenedIn Texas, 60% of eligible adults selfreported that they were update with colorectal cancer screening, which is lower than the national average.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��10&#x/BBo;&#xx [1;.04;2 7; .64;8 7;
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100.;ጁ&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;1People were considered update on screening based on the 2008 US Preventative Services Task Force Recommendations: homebased blood stool test within the past year; a colonoscopy within the past 10 years; or sigmoidoscopy within the past 5 years combined with a blood stool test within the past 3 years.&#x/BBo;&#xx [1;.04;2 7; .64;8 7;
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.4;چ ;Ā.;ጁ&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;2Colorectal Cancer Screening in the U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/colorectal/pdf/QuickFactsBRFSS2016CRC Screening508.pdf ��3Colorectal Cancer Screening in Texas. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/ncccp/screeningrates/pdf/colorectalcancerscreening texas508.pdf 0%10%20%30%40%50%60%70%80%90%100%201220142016 Percent of Respondents U.S. Texas Colore

ctal Cancer Screening Prevalence, 2016In 2016, 60% of Texas adults ages 5075 years selfreported they were update on colorectal cancer screening. This was less than the selfreported screening rate for the US (68%).��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��11&#x/BBo;&#xx [1;.49;v 3;.24;9 2;….1;Ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 3;.24;9 2;….1;Ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Image source: State Cancer Profiles. National Cancer Institute. https://statecancerprofiles.cancer.gov/quickprofiles/index.php?statename=texas#t=1 Colorectal Cancer Screening in Texas by Race/Ethnicity, Sex and Age, 20122016From 20122016, 60% percent of 15,875 Texas adults ages 5075 years selfreported they were update on colorectal cancer screening.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��12&#x/BBo;&#xx [1;.04;2 6;�.44;9 6;”.6;

23 ;€.9;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.04;2 6;�.44;9 6;”.6;ȣ ;€.9;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1Texas Health Data Community Survey Texas Behavioral Risk Factor Survey. Texas Center for Health Statistics. Rates are averaged across surveys conducted in 2012, 2014, and 2016. http://healthdata.dshs.texas.gov/CommunitySurveys/BRFSS ��People were considered update on screening based on the 2008 US Preventative Services Task Force Recommendations: homebasedblood stool test within the past year; a colonoscopy within the past 10 years; or sigmoidoscopy within the past 5 years combined with a blood stool test within the past 3 years.��Screening by Race/Ethnicity��NonHispanic (NH) White NH BlackHispanic 62% NH American Indian/Alaska NativeNH Asian/Pacific IslanderScreening by Sex MaleFemaleScreening by Age 50 to 64 Years65 to 75 Years Colorectal Cancer Screening in Texas by Education, Insurance Status and Income Level, 2012From 20122016, 60% percent

of 15,875 Texas adults ages 5075 years selfreported they were update on colorectal cancer screening.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��13&#x/BBo;&#xx [2;t.0;͇ ;ͱ.;ࡃ ;ѐ.;䖇&#x 388;&#x.343;
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Typ; /P; gin; tio;&#xn 00;High School Graduate or GEDSome College College graduate Screening by Insurance StatusInsuredUninsured Screening by Income LevelLess than $25,000$25,000$49,999$50,000 or more 69% Texas Health Data Community Survey Texas Behavioral Risk Factor Survey. Texas Center for Health Statistics. http://healthdata.dshs.texas.gov/CommunitySurveys/BRFSS Rates are averaged across surveys conducted in 2012, 2014, and 2016. People were considered update on screening based on the2008 US Preventative Services Task Force Recommendations: homebased blood stool test within the past year; a colonoscopy within the past 10 years; or sigmoidoscopy within the past 5 years combined with a blood stool test within the past 3 years. Colorectal Cancer Screening by Texas CountyThe average US screening rate in 2014 was 66%, while the average Texas rate was 61%. Seven of the 20 US counties with the lowest estimated percentages for being current with any type of colorectal cancer screening test were in Texas.Six of the countiesStarr, Maverick, Brooks, Zavala, Webb and Willacyare in South Texas.One of the countiesHudspethis in

West Texas.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��14&#x/BBo;&#xx [1;.04;2 5;.44;9 3;5.8;ࡥ ;e.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;9 3;5.8;ࡥ ;e.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;1Berkowitz et al. (2018). Cancer EpidemiolBiomarkers Prev. 27(3):245&#x/BBo;&#xx [1;.04;2 5;.44;9 3;5.8;ࡥ ;e.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;9 3;5.8;ࡥ ;e.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;Image Source: Colorectal Cancer Screening in Texas. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/ncccp/screeningrates/pdf/colorectal cancerscreeningtexas508.pdf AnyScreening Test, Mean (%)40.161.261.3 64.264.3 66.866.9 69.769.8 79.8��Countylevel CRC testing prevalence was derived from smallarea estimate mo

dels. Overview of Colorectal Cancer Incidence in TexasIncidence (New Cases)In 2016, colorectal cancer was the leading cancer diagnosis in both males and females, representing 9.2% of all new malignant cancers diagnosed in Texas.During 20122016, the colorectal cancer incidence rate was 37.7/100,000.In 2019, it is estimated that 11,533 new cases of colorectal cancer will be diagnosed in Texas. ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 CRC, 10,007 All Other Cancers, 99,077New Cancer Cases, 2016 Overview of Colorectal Cancer Mortality and Survival in TexasMortality (Deaths)In 2016, colorectal cancer was the 2leading cause of cancer death in males and the 3leading cause in females, representing 9.6% of all cancer deaths in Texas. Most deaths are from cases that were diagnosed years before.During 20122016, the colorectal cancer mortality rate was 14.2/100,000.In 2019, an estimated 4,242 Texans will die of this disease. Survival (Prevalence)There are 77,008 colorectal cancer survivors in Texas. This is the number of Texans who were diagnosed with colorectal cancer between 19952015 and

are alive as of January 1, 2016.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 CRC, 3,831 All Other Cancers , 36,168 Cancer Deaths, 2016 Definitions and AbbreviationsAgeadjusted incidence rate:number of new cancer cases diagnosed per 100,000 people per year. Numbers are ageadjusted to allow for comparison between populations with different age compositions.Ageadjusted mortality rate:number of cancer deaths per 100,000 people per year. Numbers are ageadjusted to allow for comparison between populations with different age compositions. Annual percent change(APC): measures the trend in rates over time, such as how quickly (or slowly) a cancer has increased in incidence over a given time period. For example, an APC of 2.0% over 10 years means that there was a 2% decrease in incidence rate per year. It is calculated by fitting a least squares regression line to the natural logarithm of the ageadjusted rates. The slope is tested for a significant difference from 0. If the slope changes over the assessed time period, the trend is considered to have a ‘joinpoint’.Race/ethnicity gro

up acronyms:NonHispanic (NH), Asian/Pacific Islander (A/PI), American Indian/Alaska Native (AI/AN). Note on confidence intervals (CIs):95% confidence intervals are shown and provide a range of values that have a specified probability of containing the true rate. It can be stated that 95% of the time the true rate will lie within these limits. Rates with large confidence intervals should be interpreted with caution. A 95% confidence interval around a rate that is at least as large as the rate itself is generally considered unstable. When there is no overlap in confidence intervals, rates can be considered to be significantly different. If confidence intervals partially overlap, further testing may be required to determine whether there is a statistically significant difference.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��18&#x/BBo;&#xx [2;�.62; 27;.08; 6;H.1;ّ ;̖.;匲&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/

BBo;&#xx [2;�.62; 27;.08; 6;H.1;ّ ;̖.;匲&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;Colorectal Cancer Incidence in Texas Colorectal Cancer Incidence Rates, 20122016From 2012 to 2016, Texas ranked 28out of all US states and DC in colorectal cancer incidence. The colorectal cancer incidence rate in Texas was 37.7 cases per 100,000. The US rate was 38.7.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��19&#x/BBo;&#xx [1;.49;v 3;.24;8 4;†.1;Ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 3;.24;8 4;†.1;Ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Image Source: United States Cancer Statistics: Data Visualizations. Centers for Disease Control and Prevention. https://gis.cdc.gov/Cancer/USCS/DataViz.html Rate per 100,00029.7 35.836.4 38.138.641.942.449.2 Leading Cancer Diagnoses for Males by Age, 20122016 100150200250300350400450500Kidney & Renal PelvisTes

tisColon & RectumMales, 2049 Years Old��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 100150200250300350400450500Lung & BronchusColon & RectumProstateMales, 50Years Old 100150200250300350400450500Colon & RectumLung & BronchusProstateMales, 65 Years Old and Older ��All incidence rates are per 100,000��Colorectal cancer is the most common cancer diagnosis for Texas males ages 2049, the second most common for those ages 5064, and the third most common for those ages 65 years and older. Leading Cancer Diagnoses for Females by Age, 20122016Colorectal cancer is the third most common cancer for Texas women ages 50and ages 65 years and older. It is not in the top three for those ages 20��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 100150200250300350400450500Cervix UteriThyroidBreastFemales, 2049 Years Old 100150200250300350400450500Colon & RectumLung & BronchusBreastFemales, 5064 Years Old 100150200250300350400450500Colon & RectumLung & BronchusBreastFemales, 65 Years Old and Older��All incidence rates are p

er 100,000 Colorectal Cancer Incidence Rates by Sex and Age at Diagnosis, 20122016By SexThe colorectal cancer incidence rate for combined ages was significantly higher in males (44.9 per 100,000) than females (31.6).By AgeThe incidence rate increases with age, from 12.0 for ages 2049 years to 72.3 for ages 5064 years, and 170.3 for ages 65 years and older.By Sex and AgeIncidence rates were significantly higher in males than females across all age groups. The percentage difference in incidence rate between males and females changed with age.Male incidence rates were 16% higher than female rates for ages 2049 years48% higher for ages 5064 years47% higher for ages 65 years and overHigher rates in males than females is thought to reflect risk factors, sex hormones, and differences in screening behavior.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��22&#x/BBo;&#xx [1;.04;2 5;.44;9 2;Q.5;ɥ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;9 2;Q.5;ɥ ;h.3;&#x

3 ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;1Siegel et al. (2017). CA Cancer J. Clin. 67(3):177&#x/BBo;&#xx [1;.04;2 5;.44;9 2;Q.5;ɥ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;9 2;Q.5;ɥ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;The black bars indicate the 95% confidence intervals. 95% of the time the true rate will lie within these limits. A wider barindicates uncertainty or instability in the incidence rate. 50100150200250All ages20-49 years50-64 years65 years andolder Age Adjusted Incidence Rate per 100,000 Age at diagnosis Male and Female Male Female Leading Cancer Diagnoses in Men by Race/Ethnicity, 20122016Colorectal cancer is the third most common cancer diagnosis for nonHispanic (NH) white and NH black males, and the second most common for Hispanic males. Additionally, it was also the third most common cancer diagnosis in NH Asian/Pacific Islander and NH American Indian/Alaska Native males.��Texas Cancer Re

gistry��Colorectal Cancer in Texas, June 2019 206080100120140160Colon & RectumLung & BronchusProstateNH White Males 100120140160Colon & RectumLung & BronchusProstateNH Black Males 100120140160Lung & BronchusColon & RectumProstateHispanic Males��All incidence rates are per 100,000 Leading Cancer Diagnoses in Females by Race/Ethnicity, 20122016Colorectal cancer is the third most common cancer diagnosis for nonHispanic (NH) white and NH black females, and the second most common for Hispanic females. Additionally, it was also the third most common cancer diagnosis in NH Asian/Pacific Islander and NH American Indian/Alaska Native females.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 100120140160Colon & RectumLung & BronchusBreastNH White Females 100120140160Colon & RectumLung & BronchusBreastNH Black Females 0.020.040.060.080.0100.0120.0140.0160.0Corpus & UterusColon & RectumBreastHispanic Females��All incidence rates are per 100,000 Colorectal Cancer Incidence Rates by Sex and Race/Ethnicity, 20122016For both sexes combined, incidence rates were

highest in nonHispanic (NH) blacks (47.4 per 100,000), followed by NH whites (37.9) and Hispanics (36.0).In males, rates were highest in NH blacks (56.4), followed by Hispanics (46.0) and NH whites (44.5).In females, rates were highest in NH blacks (40.9), followed by NH whites (32.1). The rate in Hispanic females (28.0) was similar to NH American Indian/Alaska Natives (AI/AN) (28.5).��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��25&#x/BBo;&#xx [1;.96;&#x 59.;ޓ ;ŗ.;砘&#x 71.;ॹ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.96;&#x 59.;ޓ ;ŗ.;砘&#x 71.;ॹ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;A/PI = Asian/Pacific Islander&#x/BBo;&#xx [1;.96;&#x 59.;ޓ ;ŗ.;砘&#x 71.;ॹ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.96;&#x 59.;ޓ ;ŗ.;砘&#x 71.;ॹ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;The black bars indicate the 95% confidence intervals. 95% of the

time the true rate will lie within these limits. A wider bardicates uncertainty or instability in the incidence rate. 102030405060 All Races NH White NH Black NH A/PI NH AI/AN Hispanic Age Adjusted Incidence Rate per 100,000 Male and Female Male Female 25.3% 27.9% 39.9% 23.3% 33.4% 49.3%23.1%23.8%20.4%26.1%24.2%17.3% 12.8% 9.9% 11.0% 16.9% 10.9% 12.9% 38.8% 38.3% 28.7% 33.7% 31.5% 20.5%10%20%30%40%50%60%70%80%90%100%20-49y50-64y65y+20-49y50-64y65y+MaleMaleMaleFemaleFemaleFemale Percent of Malignant Cases Proximal colon Distal colon Colon, other RectumColorectal Cancer Incidence by Age at Diagnosis and Tumor Location, 20122016MalesFor ages 2049 years and 5064 years, colorectal cancer was most commonly diagnosed in the rectum, followed by the proximal colon.For ages 65 years and over, colorectal cancer was most commonly diagnosed in the proximal colon, followed by the rectum.FemalesFor ages 2049 years, colorectal cancer was most commonly diagnosed in the rectum, followed the distal colon. For ages 5064 years and 65 years and older, colorectal cancer was most commonly diagnosed in the proximal colon, followed by the rectum.�

;�Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 Colorectal Cancer Incidence by Race/Ethnicity and Diagnosis Stage, 20122016NonHispanic (NH) whites had the highest proportion of cases that were diagnosed at the localized stage. NH blacks had the highest proportion of cases that were diagnosed at the distant stage.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��27&#x/BBo;&#xx [1;.49;v 3;.24;9 3; .9;… ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 3;.24;9 3; .9;… ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;AI/AN = American Indian/Alaska Native; A/PI = Asian/Pacific Islander 3.1%3.1%4.4%2.2%4.9%2.4% 32.0% 32.8% 30.9% 30.5% 29.6% 31.1%32.1%32.5%29.5%33.7%26.1%32.3% 20.2% 18.9% 23.6% 20.2% 21.8% 21.6% 12.6% 12.7% 11.6% 13.3% 17.6% 10%20%30%40%50%60%70%80%90%100%All RacesNH WhiteNH BlackNH A/PINH AI/ANHispanicPercent of Cases In situ Localized Regional Distant Unknown Colorectal Cancer

Incidence by Age and Stage, 20122016 1.9%3.6%3.0% 25.8% 31.6% 33.7%36.1%31.4%31.6% 25.4% 22.2% 17.6% 10.7% 11.2% 14.0%0%10%20%30%40%50%60%70%80%90%100%20-49y50-64y65y+Percent of CasesAge at diagnosis In Situ Localized Regional Distant UnknownFor ages 2049 years, a smaller proportion of cases were diagnosed at the localized stage (and a larger proportion at the distant stage) compared to older age groups. For ages 5064 years, a smaller proportion of cases were diagnosed at the localized stage (and a larger proportion at the distant stage) compared to ages 65 years and older.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 UrbanRural ClassificationsThe Texas Cancer Registry uses the National Center for Health Statistics (NCHS) UrbanRural Classification Scheme for Countiesto classify population areas across the state.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��29&#x/BBo;&#xx [1;.04;2 3;.24;9 3;„.6;́ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;&

#x5.04;2 3;.24;9 3;„.6;́ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1NCHS UrbanRural Classification Scheme for Counties, NCHS/CDC, Updated June 2017. CategoryDefinitionMetropolitan Large central metroCounties in metropolitan statistical areas (MSA) with populations of 1 million or more that contain entire populations in the largest principal city, have entire populations contained in largest principal city, or contain at least 250,000 inhabitants of any principal city.Large fringe metroCounties in MSAs with populations of 1 million or more that do not qualify as large central metro counties.MediummetroCounties in MSAs of populations between 250,000 999,999.Small metroCounties in MSAs of populations less than 250,000.NonmetropolitanMicropolitanCounties with an urban cluster population of 10,00049,999.NoncoreNonmetrocounties that do not qualify as micropolitan UrbanRural Classification of Texas Counties��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��30&#x/BBo;&#xx [1;.96;&#x 35.;ᤩ&#x 464;&#x.262;&#x 4

7.;͹ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.96;&#x 35.;ᤩ&#x 464;&#x.262;&#x 47.;͹ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Source: NCHS UrbanRural Classification Scheme for Counties, NCHS/CDC, Updated June 2017. Large Central MetroLarge Fringe MetroMedium MetroSmall MetroMicropolitanNon Colorectal Cancer Incidence Rates by UrbanRural Classification, 20122016In both males and females, incidence rates were higher in small metro, micropolitan, and noncore areas compared to other areas.The overall incidence rates, per 100,000, were significantly higher in nonmetro counties (41.8) compared to metro areas (37.0), and this difference occurred in both males (49.6 vs 44.1) and females (34.9 vs 31.1).��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��31&#x/BBo;&#xx [1;.04;2 5;.44;8 4;Y.8;г ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;8 4;Y.8;г ;h.3; ]/;&#xSub

t;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;12013 NCHS UrbanRural Classification Scheme for Counties. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data_access/urban_rural.htm ��The black bars indicate the 95% confidence intervals. 95% of the time the true rate will lie within these limits. A wider barindicates uncertainty or instability in the incidence rate. 102030405060Large Central MetroLarge Fringe MetroMedium MetroSmall MetroMicropolitanNon-core Age- Adjusted Incidence Rate per 100,000 Male and Female Male Female Colorectal Cancer Incidence Rates by Health Service Region, 20122016 From 20122016, 49,252 new cases of colorectal cancer were diagnosed in Texas. The incidence rate was 37.7 per 100,000 population.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��32&#x/BBo;&#xx [1;.96;&#x 35.;Ɠ ;ʅ.;࠙ ;G.3;y ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.96;&#x 35.;Ɠ ;ʅ.;࠙ ;G.3;y ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /T

y;&#xpe /;&#xPagi;&#xnati;&#xon 0;Image Source: Web Query Tool. Texas Cancer Registry. https://www.cancerrates.info/tx/ Health Service RegionNumber of CasesIncidence RateHSR 138.9HSR 243.0HSR 312,41736.7HSR 442.8HSR 543.1HSR 611,32037.5HSR 734.8HSR 838.3HSR 939.2HSR 1036.2HSR 1137.3 Colorectal Cancer Incidence Rate Trends by Sex, 20072016Colorectal cancer incidence rates declined from 45.0 in 2007 to 36.1 in 2016, which is an average yearly decrease of 2.1%.This average decline was similar in males (2.2%) and females (2.1%). In females, the decline in incidence rate was faster in 20072011 than 20112016.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 ��^ Indicates that the annual percent change (APC) was significantly different from zero.��Age-Adjusted Incidence Rate per 100,000 Year of Diagnosis Colorectal Cancer Incidence Rate Trends by Age at Diagnosis, 20072016Ages 2049 yearsIncidence rates in Texas increased from 11.1 in 2007 to 12.3 in 2016, which is an average yearly increase of 1.4%. This trend is also observed across the United States and may be rel

ated to increased rates of obesity, lack of physical activity, and unhealthy diets.Ages 50 years and olderIncidence rates significantly decreased for ages 5064 years and 65 years and older but the decrease was faster in ages 65 years and older (3.7%) than in ages 5065 years (0.7%) For ages 65 years and older the decrease was faster in 20072009 than 20092016.Declines in older adults may reflect the success of screening programs.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��34&#x/BBo;&#xx [1;.04;2 3;.24;9 2;Q.5;ɥ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.04;2 3;.24;9 2;Q.5;ɥ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;1Siegel et al. (2017). CA Cancer J. Clin. 67(3):177 ��^ Indicates that the annual percent change (APC) was significantly different from zero.��Age-Adjusted Incidence Rate per 100,000 Year of Diagnosis Colorectal Cancer Incidence Rate Trends by Age at Diagnosis and Sex, 2007

2016Trends in males and females were generally similar within each age group.Ages 2049 YearsRates significantly increased in females, but only showed a tendency to increase in males.Ages 5064 YearsTrends were similar and not significant in either sex.Ages 65 Years and OlderSimilar average declines occurred in both sexes. However, in females there was a stronger decline from 2007 to 2011 than from 2011 to 2016.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 AgeSexAverage Annual PercentChange 2007201695% Confidence Interval Year Incidence Rate, 20122016 LowerUpper 20 49 Male1.30.12.712.9 20 49 Female1.6^0.32.911.1 50 64 Male0.61.30.186.6 50 64 Female0.71.60.158.7 65 and older Male3.6^4.32.9207.6 65 and older Female3.6^4.42.8141.2 Trend was significantly different than 0 Colorectal Cancer Incidence Rate Trends by Race/Ethnicity, 20072016Colorectal cancer incidence rates decreased significantly by an average of 2.1% per year in nonHispanic (NH) whites, 3.3% in NH blacks, 2.4% in NH Asian/Pacific Islanders (A/PI), and 1.3% in Hispanics. The rate in NH American Indian/Alaska Natives (AI/A

N) remained stable (a nonsignificant 1.2% increase).In NH whites, the decline was stronger during 20072010 than during 20102016. In NH blacks, the decline was stronger during 20072012 than during Despite a faster decline in NH blacks, 2016 incidence rates remained highest for this group.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 ��^ Indicates that the annual percent change (APC) was significantly different from zero.��Rates for NH AI/AN had large confidence intervals.��Age-Adjusted Incidence Rate per 100,000 Year of Diagnosis Colorectal Cancer Incidence Rate Trends by Sex and Race/Ethnicity, 20072016Trends were similar in males and females for most race ethnicity groups.The decline in incidence was significant in male Hispanics but not in female Hispanics.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��37&#x/BBo;&#xx [1;.49;v 4;.84;8 3;‘.5;। ;X.7; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.49;v

4;.84;8 3;‘.5;। ;X.7; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;NH = nonHispanic; A/PI = Asian/Pacific Islander; AI/AN = American Indian/Alaska Native&#x/BBo;&#xx [1;.49;v 4;.84;8 3;‘.5;। ;X.7; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.49;v 4;.84;8 3;‘.5;। ;X.7; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;Counts for NH AI/AN were low and gave annual rates with large confidence intervals. Race/EthnicitySexAverage APC2007201695% Confidence Interval Year Incidence Rate, 20122016 LowerUpperNH WhiteMale2.2^2.81.644.5NH WhiteFemale2.0^2.91.132.1NH BlackMale3.5^4.72.256.4NH BlackFemale3.2^4.51.940.9NH A/PIMale2.95.90.328.0NH A/PIFemale2.24.80.422.6NH AI/ANMale2.99.54.327.9NH AI/ANFemale7.01.916.828.5Hispanic Male1.3^2.40.246.0Hispanic Female1.63.20.128.0 Trend was significantly different than 0 Colorectal Cancer Incidence Rate Trends by Age at Diagnosis and Race/Ethnicity, 20072016 AgeRace/ethnicityAverage APC 201695% Confidence

IntervalYearncidenceRate, 2012LowerUpper 20 49 NH white 14.0 NH black 13.5 NH A/PI 0.5-4.27.6 NH AI/AN 16.8 Hispanic 1.0-2.29.9 50 64 NH white 69.3 NH black 100.8 NH A/PI 50.2 NH AI/AN 10.044.6 Hispanic 69.7 65 and older NH white 168.3 NH black 208.7 NH A/PI 111.9 NH AI/AN 10.0139.7 Hispanic 167.32049 YearsIncidence rates increased significantly in nonHispanic (NH) whites only (2.4%).year incidence rates during 20122016 were highest in NH whites, followed by NH blacks.5064 YearsIncidence rates decreased significantly in NH blacks only (2.1%).The 5year incidence rates during 20122016 were highest in NH blacks.65 Years and OlderIncidence rates decreased significantly all groups except NH American Indian/Alaska Native (AI/AN).The 5year incidence rates during 20122016 were highest in NH blacks.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 Trend was significantly different than 0��A/PI = Asian/Pacific Islander Colorectal Cancer Incidence Rate Trends by Metro/NonMetro Counties, 20072016 There was a significant decline in colorectal cancer incidence from 2007 to 2016 in both

metro and nonmetro counties, but the average yearly decline was significantly faster in metro counties (2.3%) compared to nonmetro counties (1.2%). In metro areas the decline was faster during 20072011 than during 2011By 2016, the incidence rate was significantly higher in nonmetro areas than in metro areas.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 ��^ Indicates that the annual percent change (APC) was significantly different from zero.��Age-Adjusted Incidence Rate per 100,000 Year of Diagnosis ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��40&#x/BBo;&#xx [2;�.62; 27;.08; 6;4.9;
3;.5;̲ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [2;�.62; 27;.08; 6;4.9;
3;.5;̲ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Colorectal Cancer Mortality in Texas Colorectal Cancer Mortality Rates, 20122016From 2012 to 2016, Texas ranked 25out of all US states and DC in colorectal

cancer mortality. The colorectal cancer mortality rate in Texas was 14.3 cases per 100,000. The US rate was 14.2.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��41&#x/BBo;&#xx [1;.49;v 3;.24;8 4;†.1;Ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 3;.24;8 4;†.1;Ȳ ;F.1;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;Image Source: United States Cancer Statistics: Data Visualizations. Centers for Disease Control and Prevention. https://gis.cdc.gov/Cancer/USCS/DataViz.html Rate per 100,00011.2 13.213.3 14.214.3 15.415.5 18.7 102030405060708090100All ages20-49y50-64y65y+ Age adjusted Mortality Rate per 100,000 Age at death Male and female Male FemaleColorectal Cancer Mortality Rates by Sex and Age, 20122016By SexIn Texas from 2012 to 2016, there were 14.2 deaths from colorectal cancer per 100,000 people per year.The mortality rate was significantly higher in males (17.7) than females (11.4).By Sex and AgeMortality rates incre

ased with age from 2.9 for patients diagnosed at ages 2049 years to 22.2 at ages 64 years to 76.0 at ages 65 years and older.Rates were significantly higher for males than females in all age groups.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��42&#x/BBo;&#xx [1;.49;v 3;.24;9 6;’.7;† ;U.7; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.49;v 3;.24;9 6;’.7;† ;U.7; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;The black bars indicate the 95% confidence intervals. 95% of the time the true rate will lie within these limits. A wider barindicates uncertainty or instability in the mortality rate. Colorectal Cancer Mortality Rates by Sex and Race/Ethnicity, 20122016 1015202530AllNH WhiteNH BlackNH A/PINH AI/ANHispanic Age adjusted Mortality Rate per 100,000 Male and female Male FemaleOverall, mortality rates were highest in nonHispanic (NH) blacks, followed by NH whites and Hispanics.In males, rates were highest in NH blacks, followed by His

panics and NH whites.In females, rates were highest in NH blacks, followed by NH whites and Hispanics.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��43&#x/BBo;&#xx [1;.49;v 5;.44;8 3;.4;ͣ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.49;v 5;.44;8 3;.4;ͣ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;A/PI = Asian/Pacific Islander; AI/AN = American Indian/Alaska Native&#x/BBo;&#xx [1;.49;v 5;.44;8 3;.4;ͣ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.49;v 5;.44;8 3;.4;ͣ ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;The black bars indicate the 95% confidence intervals. 95% of the time the true rate will lie within these limits. A wider barindicates uncertainty or instability in the mortality rate. Colorectal Cancer Mortality Rates by Sex and UrbanRural Classification, 20

122016 10152025Large centralmetroLarge fringemetroMedium metroSmall metroMicropolitanNoncore Age adjusted Mortality Rate per 100,000 Male and female Male Female��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��44&#x/BBo;&#xx [1;.04;2 5;.44;8 4;Y.8;г ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [1;.04;2 5;.44;8 4;Y.8;г ;h.3; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;12013 NCHS UrbanRural Classification Scheme for Counties. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data_access/urban_rural.htm ��The black bars indicate the 95% confidence intervals. 95% of the time the true rate will lie within these limits. A wider barindicates uncertainty or instability in the mortality rate.��•In both males and females mortality rates were lower in large central metro, large fringe metro, and medium metro areas compared to in small metro, micropolitan, and noncore areas.��

;•The overall mortality rate, per 100,000, was significantly higher in nonmetro (15.9) versus metro areas (13.9), for males (19.7 vs 17.4) and females (12.5 vs 11.2). Colorectal Cancer Mortality Rates by Health Service Region, 20122016From 20122016, 18,140 Texans died of colorectal cancer. The mortality rate was 14.2 per 100,000 population.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��45&#x/BBo;&#xx [1;.96;&#x 35.;Ɠ ;ʅ.;࠙ ;G.3;y ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.96;&#x 35.;Ɠ ;ʅ.;࠙ ;G.3;y ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Image Source: Web Query Tool. Texas Cancer Registry. https://www.cancerrates.info/tx/ Health Service RegionNumber of CasesMortality RateHSR 115.7HSR 217.5HSR 313.8HSR 415.3HSR 516.3HSR 614.4HSR 712.8HSR 814.7HSR 915.4HSR 1013.1HSR 1113.3 Colorectal Cancer Mortality Rate Trends by Age, 20072016��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��4

6&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;^ Indicates that the annual percent change (APC) was significantly different from zero.&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Because similar trends were observed for both males and females within each age group, both sexes were analyzed together.&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Ages 2

049 Years&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Colorectal cancer mortality increased by 1.9% per year from 20072016.&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Ages 5064 Years&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Rates remained stable with an average decrease of 0.2% per year.&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328

; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Ages 65 Years and Older&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Rates decreased significantly by 3.0% per year.&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;&#x/BBo;&#xx [1;.9;Ғ ;Ř.;ᕔ&#x 379;&#x.328; 17;.64; ];&#x/Sub;&#xtype;&#x /Fo;&#xoter;&#x /Ty;&#xpe /;&#xPagi;&#xnati;&#xon 0;Age-Adjusted Mortality Rate per 100,000 Year of Diagnosis Colorectal Cancer Mortality Rate Trends by Race/Ethnicity, 20072016 NonHispanic (NH) WhitesMortality rates decreased by an average of 1.8% per ye

ar. Rates tended to decrease between 2007 and 2009. Rates significantly decreased by 1.2% per year from 20092016. NH BlacksMortality rates decreased by an average of 2.8% per year but this was not significantly different from 0. Rates significantly decreased by 4.7% per year from 20072014, then tended to increase from 20142016.NH Asian/Pacific IslanderMortality rates tended to decrease but this trend was not significant.HispanicMortality rates decreased significantly from 20072016 by 1.4% per year.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��47&#x/BBo;&#xx [2;).7;ळ ;ł.;ā&#x 347;&#x.972;&#x 181;&#x.696; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [2;).7;ळ ;ł.;ā&#x 347;&#x.972;&#x 181;&#x.696; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;^ Indicates that the annual percent change (APC) was significantly different from zero.&#x/BBo;&#xx [2;).7;ळ ;ł.;ā&#x 347;&#x.972;&#x 181;&#x.696; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin;&

#xatio;&#xn 00;&#x/BBo;&#xx [2;).7;ळ ;ł.;ā&#x 347;&#x.972;&#x 181;&#x.696; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;Rates for NH American Indian/Alaska Native are not shown due to low counts and unstable rates.&#x/BBo;&#xx [2;).7;ळ ;ł.;ā&#x 347;&#x.972;&#x 181;&#x.696; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;&#x/BBo;&#xx [2;).7;ळ ;ł.;ā&#x 347;&#x.972;&#x 181;&#x.696; ]/;&#xSubt;&#xype ;&#x/Foo;&#xter ;&#x/Typ; /P; gin; tio;&#xn 00;Age-Adjusted Mortality Rate per 100,000 Year of Diagnosis ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��48&#x/BBo;&#xx [2;�.62; 27;.08; 6;!.7; ;̖.;匲&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;&#x/BBo;&#xx [2;�.62; 27;.08; 6;!.7; ;̖.;匲&#x ]/S;&#xubty;&#xpe /;oot;r /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x 000;Colorectal Cancer Survival in Texas Colorectal Cancer CauseSpecific Survival* by Stage and Race/Et

hnicity, 20072016As with other cancers, survival was lowest for patients diagnosed at the distant stage and highest for those diagnosed at the localized stage.For tumors diagnosed at all stages, survival was highest for nonHispanic (NH) Asian/Pacific Islanders (A/PI). NH blacks had the lowest survival for each staging group. NH blacks also had the highest proportion of cases diagnosed at the distant stage (see Colorectal Cancer Incidence by Race/Ethnicity and Diagnosis Stage, 20122016 ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019��49&#x/BBo;&#xx [1;.49;v 5;.44;8 7;.7;Ȳ ;w.9;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 5;.44;8 7;.7;Ȳ ;w.9;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;* Causespecific survival estimated the percentage of patients diagnosed between 2007 and 2016 that did not die from colorectal cancer within 5year after diagnosis. Individuals who died of other causes are censored.&#x/BBo;&#xx [1;.49;&#x

76 5;.44;8 7;.7;Ȳ ;w.9;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;&#x/BBo;&#xx [1;.49;v 5;.44;8 7;.7;Ȳ ;w.9;́ ;&#x]/Su;typ; /F;&#xoote;&#xr /T;&#xype ;&#x/Pag;&#xinat;&#xion ;The black bars indicate the 95% confidence intervals. 95% of the time the true survival percentage will lie within these limits.A wider bar indicates uncertainty or instability in the survival percentage. 0%10%20%30%40%50%60%70%80%90%100%LocalizedRegionalDistantUnknownYear CauseSpecific Survival* NH white NH black NH A/PI NH AI/AN Hispanic Colorectal Cancer Relative Survival* by Stage and Age at Diagnosis, 20072016As with other cancers, 5year relative survival was highest for tumors diagnosed at the localized stage, and lowest for tumors diagnosed at the distant stage.At each stage, survival was highest for younger adults than for older age classes.However, a larger proportion of tumors are diagnosed at the distant stage in younger adults than in older adults (see Colorectal Cancer Incidence by Age and Stage, 20122016 ��Texas Cancer Registr

y��Colorectal Cancer in Texas, June 2019 0%10%20%30%40%50%60%70%80%90%100%LocalizedRegionalDistantUnknownYear Relative Survival*Tumor location 20-49y 50-64y 65y+��* Relative survival measures cancer survival in the absence of other causes of death and uses expected life tables to comparee ratio of observed cancer survivors to the expected survival of the wider (cancer free) population (of similar race, sex, and age). Tumors diagnosed between 2007 and 2016 were included, with survival followup through December 2017.��The black bars indicate the 95% confidence intervals. 95% of the time the true survival percentage will lie within these limits.A wider bar indicates uncertainty or instability in the survival percentage. Technical NotesData Source: Texas Cancer Registry (www.dshs.state.tx.us/tcr) SEER*Stat Database, Incidence Texas, 19952016, statewide, Texas Department of State Health Services, created February 2019, based on NPCRCSS Submission, cutoff 11/09/18.Data Source: Texas Cancer Registry (www.dshs.texas.gov/tcr) SEER*Stat Database, Mortality Texas, 19902016, statewide, Texas Depart

ment of State Health Services (created June 2019).Incidence and mortality rates are ageadjusted to the 2000 US Standard population in 2000 (19 Ages Groups Census P251130). The annual percentage change (APC) was calculated using Joinpoint by fitting a least squares regression line to the natural logarithm of the ageadjusted rates, with calendar year as the regressorvariable. This method allows more than one APC to describe the trend over a time period. An average APC is the weighted average of the APCs from the joinpointmodel, and can be used to summarize a trend even when there were changes in trends over the assessed time period.Error bars represent 95% confidence intervals around rates and were calculated using the Tiwari et al. modification in SEER*Stat.The CDC’s National Center for Health Statistics (NCHS) UrbanRural Classification Scheme for Counties was used in this report. This scheme is a sixlevel urbanrural classification scheme for US counties. The most urban category consists of central counties in large metropolitan areas; the most rural category consists of nonmetropolitan “noncore” counties. (Source

: NCHS UrbanRural Classification Scheme for Counties, NCHS/CDC, Updated June 2017. Accessed April 2018. https://www.cdc.gov/nchs/data_access/urban_rural.htm ). ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 ReferencesBerkowitz, Z., Zhang, X., Richards, T.B. et al. (2018) Multilevel smallarea estimation of colorectal cancer screening in the United States. Cancer Epidemiolology, Biomarkers & Prevention, 27(3),245253.Islami, F., GodingSauer, A., Miller, K. D., Siegel, R. L., Fedewa, S. A., Jacobs, E. J., Jemal, A., et al. (2017). Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA: A Cancer Journal for Clinicians, 68(1), 3154.Siegel, R., DeSantis, C., & Jemel, A. (2017). Colorectal cancer statistics, 2014. CA: A Cancer Journal for Clinicians, 67(3), 177193.��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 Additional Resources for Colorectal Cancer ScreeningAmerican Cancer Society colorectal cancer screening guidelines: https://www.cancer.org/cancer/colonrectalcancer/detec

tiondiagnosisstaging/acsrecommendations.html National Cancer Institute colorectal cancer screening patient information: https://www.cancer.gov/types/colorectal/patient/colorectalscreening CDC colorectal cancer screening brochure: https://www.cdc.gov/cancer/colorectal/pdf/no_pocket_brochure.pdf ��Texas Cancer Registry��Colorectal Cancer in Texas, June 2019 AcknowledgmentThe Texas Cancer Registry (TCR) recognizes the following whose financial support is essential to accomplishing the Registry’s mission for our State.Federal Grant FundingWe acknowledge the Centers for Disease Control and Prevention (CDC) for its financial support under Cooperative Agreement #1NU58DP006308.State Agency FundingTexas Department of State Health ServicesTexas Health and Human Services CommissionCancer Prevention and Research Institute of TexasThe TCR also wants to thank all cancer reporters for their hard work and collaboration. Cancer reporters help us meet national high quality and timeliness standards, and enable us to serve as the primary source of cancer data in Texas.��Texas Cancer Registry�